How bereavement affects children Children of differing ages react in a number of ways to the death of someone close, and not always as an adult may behave. Dr Ann Dent explains how toddlers, children and adolescents view death, and outlines some of the symptoms to look out for.

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How do children learn about death?

Do children grieve differently?

As adults, we know that death is universal, inevitable and the end of physical life. But children's understanding of death comes gradually.

Under five years:

• children of this age have little abstract sense of time or distance, so final and forever mean nothing
• dead means less alive
• death is a sleep or a journey
• death and life are interchangeable

From five to eight years:

• death is a frightening person - a lucky person may not be caught
• death is final
• death is often seen as the end result of violence and aggression
• there's an intense interest in the rituals surrounding death

From around nine years onwards:

• death is the perceptible end of bodily life
• dead is dead
• death is inevitable, final and universal

So from about nine years, most children will have an adult view of death, although this will depend on their development and their past experiences of death. The best way of understanding what children think and feel about death is to listen carefully and be guided by them.

Children learn to adapt to a wide range of changes, such as being weaned, losing a favourite toy, going to school, moving schools or moving house and leaving friends, and possibly coping with the death of a pet.

Loss isn't unknown to children

They may have experienced a wide range of feelings during these events, including anger, guilt, confusion, sadness and depression. So loss isn't unknown to children, although they may have little understanding of their reactions or how to express what they feel.

How children cope with loss will depend to some extent on their personalities, but mostly in the way their parents or carers have guided them. These models may stay with them through to adulthood.

Until recently, it was thought that children didn't grieve. Research now shows that children do grieve for the death of a significant person in their lives, experiencing similar feelings to bereaved adults. Because their level of understanding about death varies as they develop, it may be more difficult to determine and understand what they're feeling, especially in children under five.

Babies and toddlers. Babies and toddlers may not understand about death but will react to those around them. For example, a grieving mother will inadvertently convey her sad feelings to her baby, who in turn may respond by constantly crying.

Primary school children. Older children may experience similar feelings to adults, such as shock, confusion, anger and guilt. Children of this age may not show their feelings openly, leading parents and others to believe that they aren't affected by the death. Any altered behaviour may indicate that they too are suffering and need support and acknowledgement of their pain. Common behaviour changes include becoming withdrawn, bed-wetting, lack of concentration, clinging, bullying, telling lies and being aggressive, all of which may indicate their upset state.

Teenagers. Teenagers' grief reactions are similar to those of adults but negative feelings may lead to violence and aggression. Mood swings and periods of depression are common but it may be difficult to separate them from normal adolescent behaviour. Tension and fighting within the family may become more common. Like adults, teenagers may suffer from headaches, sleep difficulties and eating disturbances.

The following are comments expressed by bereaved children of all ages, demonstrating clearly some of the feelings they may experience:

• Denial - "I don't believe it. It didn't happen. It's just a dream. Daddy will come back."
• Guilt - "She got sick because I was naughty. I killed her!"
• Blaming others - "It's the doctor's fault. He didn't treat him right."
• Anxiety - "Who's going to take care of me now?"